NEW YORK STATE SENATE VETERAN’S HALL OF FAME

Nomination Form
Please email, fax or hand deliver this form to Senator Ken LaValle by April 14, 2014. Attention: Veteran’s Hall of Fame Email: LaValle@nysenate.gov with subject line: Vets Hall of Fame Fax: 631-473-1513 Name of Nominee: ____________________________________ Address of Nominee: __________________________________ ___________________________________________________ Nominee Phone: ( ) Nominee Email: ________________@_______ Branch of Military: Name of person nominating the Veteran: _____________________ Your: Phone Number: ( ) Email: ________________@_______ TO COMPLETE YOUR NOMINATION: 1. 2. 3. Please ATTACH a SEPARATE document describing the reasons for your nomination in 250 words or less. A clear HIGH RESOLUTION digital photo Please include your nominees rank and file at time of discharge or end of military service, military awards and achievements.

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